--Propofol is a very nice drug and safe drug. Unless you are a dumba$$ like Micheal Jackson or his pretend physician. Its effects are almost like a light switch, off and on, with very little after effects. Has almost no nausea/vomiting. Unlike the drugs used for moderate sedation. I have had one too many friends spend the rest of the afternoon puking their guts up and holding their head over the toilet because the GI doc doesn't know better.

--having an anesthesiologist is a safety factor. With a sicker and aging population, even giving moderate sedation is not without risk. Think of driving while texting, not a good idea. Having the GI doc doing the procedure and directing the nurse on how much sedation to give and monitoring the patients respiratory status, blood pressure, etc., etc. is an equally divided attention situation. You might get by for awhile, but sooner or later you're asking for trouble.

--I'm sure malpractice insurance plays a role in this. One too many filings against GI docs for complications/deaths while they weren't paying attention. "Do you swear to tell the truth, the whole truth, so help you personal deity?", "Yes", "Are you board certified or have received any extensive training in anesthesia/sedation?", "No", "Plantiff rests its case your honor". Bam, insurance rates go up. Same thing happened with OB/Gyn's that used to do their own labor epidurals. Too many things went wrong and insurance companies quit covering.

--knowing you're having general anesthesia and NOT finding out if the anesthesiologist participates in your insurance plan is YOUR fault.

--many insurance companies have started denying reimbursement of general anesthesia in adults for GI procedures. Unless extenuating circumstances are documented by the GI doc/internist. Multiple medical problems, dementia/uncooperative, etc., etc. They still reimburse without question for pediatric GI procedures (under 18). It might change after one too many insurance CEOs/families have one too many FUBARs.

--the over billing you can blame on the government and Medicare/Medicaid. Its not an attempt at making up for low/no reimbursement of M/M. Its to actually maintain a normal bill. M/M reimburse based on local "customary rates". Say I normally charge $100/hr. Insurance companies negotiate a 50% discount. M/M then look at that customary rate and reimburse 20% or $20/hr. So if I get someone in a plan I don't participate in, I charge them $100/hr. If I said $50/hr, M/M would come in and say, OK 20% of your new customary charge is now $10/hr. Insurance companies usually try to negotiate off M/M plus X%, so they would be trying to lower things when contracts are up. So you could soon be in a death spiral of lower reimbursement rates. Yes it sounds like a stupid circle jerk but its called self preservation. I do enough free care as it is.

--if you think things are bad now, wait till healthcare is "free". Your anesthesia could be a choice between a mallet or a stick. Assuming you survive the waiting list.

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